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INTRODUCTION

The previous chapter defined health disparities as systematic, yet potentially modifiable, differences in health between more and less privileged social groups. This chapter focuses more narrowly on health-care disparities. After defining this term, the factors that contribute to health-care disparities, the patients affected by these inequities in access to and quality of care, and strategies to eliminate health-care disparities are discussed focusing on these issues in the US health-care setting.

QUALITY OF CARE AND HEALTH-CARE DISPARITIES

The Institute of Medicine has defined quality as “the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.”1 Quality can be impaired in different ways, such as overuse, underuse, and misuse. There are major deficiencies on all of these accounts in the quality of care provided by the US health-care system. For example, there are major deficiencies in the quality of care provided to patients with common chronic diseases: two-thirds of patients with high blood pressure are inadequately treated; the majority of patients with diabetes have glycohemoglobin (A1C) levels >7%; and half of the patients hospitalized with congestive heart failure are readmitted within 90 days of discharge.

Furthermore, many studies have shown that social status can contribute to the quality of care a patient receives. Social status may alter health-care professionals’ perceptions of patients’ needs or the way in which patients interact with health services and this in turn may influence the quality of care that is received. In the United States, for example, patients from racial and ethnic minority groups as compared with white patients experience more frequent barriers to care, more limited treatment options when presenting for care, and greater deficits in the quality of care. Such health-care disparities are seen in association with measures of social status throughout the world. For example, in the United Kingdom, quality of care for patients with diabetes is positively associated with income.2

These health-care inequities reflect systematic differences in access to or quality of care between more and less privileged groups that cannot be explained by the differences in the need for care or preference for care among the individuals in these groups (Figure 2-1).

Figure 2-1.

Model of health-care disparities. The Gomes and McGuire model views health-care disparities as resulting from characteristics of the health-care system, the society’s legal and regulatory climate, discrimination, bias, stereotyping, and uncertainty. Not all dissimilarities in care are considered a disparity in care. (Adapted from Gomes C, McGuire T. Identifying ...